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First Responder medications Flashcards

Comprehensive ICARDS of medications for first responders including out of scope

1
Q

What are your indications for aspirin as a first responder?

A

Myocardial Ischemia and ST elevation myocardial infarction (STEMI)

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2
Q

What are the contraindications and cautions of aspirin?

A

Contraindications- Known severe allergy and 3rd trimester pregnancy
Cautions- Known bleeding disorder, clinically significant bleeding and worsening of bronchospasm with non-steroidal anti-inflammatory drugs (NSAIDs).

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3
Q

What is the mechanism of action (MOA) of aspirin?

A

It has antiplatelet, antipyretic, anti-inflammatory and analgesic effects. Out-of-hospital it is administered for its antiplatelet activity.

Aspirin inhibits the enzyme cyclooxygenase which causes a reduction in the formation of prostaglandins and thromboxane

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4
Q

What is your routes of administration for aspirin as a first responder?

A

Per oral.

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5
Q

What is your dosages for aspirin as a first responder?

A

300mg

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6
Q

What are the common side effects of aspirin?

A

increased bleeding and indigestion, gastrointestinal ulceration and gastrointestinal bleeding with long term administration.

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7
Q

Do you have to call clinical desk to administer aspirin as a first responder?

A

No

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8
Q

What are your indications for glucose gel as a first responder?

A

Hypoglycemia in adults and children provided the patient can safely swallow and hypoglycemia in neonates.

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9
Q

What the cautions and contraindications for glucose gel?

A

None

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10
Q

What is the mechanism of action (MOA) for glucose gel?

A

Glucose gel provides exogenous glucose source that can be easily swallowed and rapidly absorbed.

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11
Q

What are your routes of administration for glucose gel as a first responder?

A

Per oral (PO)

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12
Q

What are your dosages for glucose gel as a first responder?

A

10-20 g

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13
Q

What are the common side effects of glucose gel?

A

None

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14
Q

Do you have to call clinical to administer glucose gel as a first responder?

A

No

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15
Q

What are your indications for ibuprofen as a first responder?

A

Mild to moderate pain, usually in combination with paracetamol and moderate to severe pain usually in combination with other medicines.

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16
Q

What are the contraindications and cautions for ibuprofen?

A

Contraindications- Known severe allergy, pregnancy, sepsis, dehydration, shock, clinically significant bleeding and known worsening of bronchospasm following non-steroidal anti-inflammatory drugs (NSAIDs).
Cautions- patient has taken ibuprofen within the last 4 hours, abdominal pain and aged greater than or equal to 75 years, particularly if frail.

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17
Q

What is the mechanism of action (MOA) of ibuprofen?

A

It is an non-steroidal anti-inflammatory drug (NSAID) predominantly used for treating pain.
It inhibits the enzyme prostaglandin synthetase reducing prostaglandin production which reduces inflammation, pain and fever.

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18
Q

What are your routes of administration for ibuprofen as a first responder?

A

Per oral (PO)

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19
Q

What are your dosages for ibuprofen as a first responder?

A

600mg for an adult over 80 kg
400mg for an adult under 80kg
refer to pediatric drug dose tables for a child.

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20
Q

What are the common side effects of ibuprofen?

A

Renal impairment, increased bleeding and indigestion, gastrointestinal ulceration and gastrointestinal bleeding with long term administration.

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21
Q

Do you need to call clinical to administer ibuprofen as a first responder?

A

If you are looking to administer a 600mg dose or liquid suspension otherwise no.

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22
Q

What are your indications for paracetamol as a first responder?

A

Mild to moderate pain and moderate to severe pain usually in combination with other medicines.

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23
Q

What are the contraindications and cautions of paracetamol?

A

Contraindications- Known severe allergy
Cautions- Taken paracetamol within the last 4 hours, abdominal pain, known severe liver disease.

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24
Q

What is the mechanism of action (MOA) for paracetamol?

A

It inhibits the production of prostaglandins resulting in a reduction in pain and fever.

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25
What are your routes of administration for paracetamol as a first responder?
Per oral (PO)
26
What are the common side effects of paracetamol?
none
26
What are your dosages for paracetamol as a first responder?
1500mg for an adult over 80kg 1000mg for an adult under 80kg refer to pediatric drug dosage table for a child
27
Do you have to call clinical desk to administer paracetamol as a first responder?
If you are looking to administer a 1500mg dose or liquid suspension otherwise no.
28
What are your indications for adrenaline as a first responder?
Anaphylaxis, severe asthma, stridor causing moderate to severe respiratory distress, clinically significant epistaxis, clinically significant bleeding from a wound.
29
What are the contraindications and cautions for adrenaline?
Contraindications- none Cautions- myocardial ischemia and tachydysrhythmias
30
What is the mechanism of action (MOA) of adrenaline?
Adrenaline predominantly agonizes alpha 1, beta 1 and beta 2 receptors. Alpha 1 stimulation causes smooth muscle contraction, vasoconstriction, glycogenolysis and gluconeogenesis Beta 1 stimulation causes an increase in inotropy (cardiac contractility), chronotropy (heart rate) and dromotropy (speed of electrical conduction through the heart). Beta 2 stimulation causes smooth muscle relaxation, skeletal muscle vasodilation, bronchodilation and reduction in histamine release through stabilisation of mast cell membranes.
31
What are your routes of administration for adrenaline as a first responder?
Intramuscular (IM)(anaphylaxis, severe asthma), nebulised (stridor causing moderate to severe respiratory distress), intranasal (IN)(Clinically significant epistaxis) and topical (Clinically significant bleeding from a wound).
32
What are your dosages for adrenaline administration as a first responder?
0.5mg intramuscular undiluted for an adult. For a child refer to pediatric drug dosage table. 5mg nebulised undiluted 0.2mg intranasal per bleeding nostril diluted to 1:10,000 with 0.9% sodium chloride for an adult. For a child refer to pediatric drug dosage table. Any amount of solution diluted to 1:10,000 with 0.9% sodium chloride for topical.
33
What are the common side effects of adrenaline administration?
Tachycardia, tachydysrhythmia, myocardial ischemia, Ventricular ectopy, hypertension, nausea, vomiting, tremor, anxiety, sweating and hyperglycemia
34
Do you have to call clinical for adrenaline administration as a first responder?
Yes unless the patient has their own auto-injector
35
What are your indication for midazolam as a first responder?
Generalised seizures lasting longer than 5 minutes or are recurrent.
36
What are the contraindications and cautions for midazolam administration?
Contraindications- known severe allergy, aged less than 12 years (Not applicable to indications for first responders) Cautions- Altered level of consciousness, respiratory depression, signs of shock, concurrent administration of opiates or ketamine and aged greater than or equal to 75 particularly if frail.
37
What are the contraindications and cautions for midazolam administration?
It is a benzodiazepine. It enhances the activity of gamma-aminobutyric acid (GABA) at GABA receptors within the central nervous system resulting in anticonvulsant activity, sedation, amnesia, anxiolysis and muscle relaxation.
38
What are your routes of administration for midazolam as a first responder?
Intramuscular (IM)
39
What are your dosages for midazolam administration as a first responder?
10mg for an adult. Refer to pediatric drug dose table for a child.
40
What are the common side effects of midazolam?
Sedation, respiratory depression, hypotension and amnesia.
41
Do you have to call clinical desk for midazolam administration as a first responder?
Yes
42
What are your indications for ceftriaxone administration as a first responder?
Suspected meningococcal septicaemia
43
What are the contraindications and cautions for ceftriaxone?
Contraindications- anaphylaxis to cephalosporins Cautions- none
44
What is the mechanism of action for ceftriaxone?
It is a cephalosporin antibiotic with broad activity against gram-negative and positive bacteria. It inhibits production of the bacterial cell wall causing bacteria to die.
45
What are your routes of administration for ceftriaxone as a first responder?
Bilateral intramuscular (IM)
46
What are your dosages for ceftriaxone administration as a first responder?
2g diluted with 0.9% sodium chloride following the procedure in the clinical procedures an guidelines resulting in 1g diluted to 5mL in 2 syringes (2g/10mL) for an adult. Refer to pediatric drug dosage table for a child.
47
What are the common side effects of ceftriaxone?
None
48
Do you have to call clinical desk for ceftriaxone administration as a first responder?
Yes
49
What are your indications for glyceryl trinitrate as a first responder?
Myocardial ischaemia, cardiogenic pulmonary odema, control of hypertension associated with autonomic dysreflexia and STEMI.
50
What are the contraindications and cautions for glyceryl trinitrate?
Contraindications- Known severe allergy, systolic blood pressure less than 110 mmHg, heart rate less than 40/min, heart rate greater than 150/min and ventricular tachycardia. Cautions- STEMI, frail, signs of shock, dysrhythmia, phosphodiesterase inhibitor administration with the last 24 hours and known aortic or mitral stenosis.
51
What is the mechanism of action for glyceryl trinitrate?
It is a vasodilator. It acts on vascular smooth muscle to cause venous and arterial vasodilation with predominant effect being on the veins. The mechanism is not clear it appears to result in the formation of nitric oxide which is a vasodilator. It causes a reduction in preload which reduces ventricular filling and cardiac output which reduces myocardial oxygen demand, arterial dilation reducing afterload which reduces the force the left ventricle has to overcome to eject blood reducing myocardial oxygen demand and dilation of coronary arteries which may increase coronary blood supply although this is not usually clinically significant.
52
What are your routes of administration for glyceryl trinitrate as a first responder?
Sublingual (SL)
53
What are your dosages for glyceryl trinitrate administration as a first responder?
0.4mg with exception of cardiogenic pulmonary oedema which is 0.8mg.
54
What are the common side effects of glyceryl trinitrate administration?
Hypotension, flushing, headache, tachycardia, light-headed
55
Do you have to call clinical desk for glyceryl trinitrate administration as a first responder?
Yes unless the patient has their own prescribed for myocardial ischemia only.
56
What are the indications for methoxyflurane administration as a first responder?
Moderate to severe pain particularly when there will be a significant delay in opiate pain relief.
57
What are the contraindications and cautions for methoxyflurane administration?
Contraindications- known severe allergy, personal or family history of malignant hyperthermia, known renal impairment, methoxyflurane administered with in the last week. Cautions- aged greater than or equal to 75 years particularly if frail, pre-eclampsia, administration within a confined space and acute exacerbation of chronic pain.
58
What is the mechanism of action (MOA) of methoxyflurane?
It is an inhaled analgesic with an unclear mechanism of action.
59
What are your routes of administration of methoxyflurane as a first responder?
Inhaled
60
What are your dosages for methoxyflurane administration as a first responder?
3mL
61
What are the common side effects of methoxyflurane?
Sedation and light-headed.
62
Do you have to call clinical desk to administer methoxyflurane as a first responder?
Yes
63
What are your indications for loratadine administration as a first responder?
Minor allergic reactions confined to skin involvement and prominent itch associated with anaphylaxis provided all systemic signs have resolved.
64
What are the contraindications and cautions for loratadine?
Contraindications- known severe allergy and aged less than one year. Cautions- pregnancy
65
What is the mechanism of action for loratadine?
It is a non-sedating antihistamine. It antagonises peripheral histamine receptors blocking the action of histamine reducing itching and redness.
66
What are the routes of administration for loratadine as a first responder?
Per oral (PO)
67
What are the dosages for loratadine administration as a first responder?
10 mg for adult or child aged greater than 12 years. 5mg for children aged 1-11 years.
68
What are the common side effects of loratadine administration?
None
69
Do you have to call clinical desk to administer loratadine as a first responder?
No
70
What are the indications for prednisone/prednisolone administration as a first responder?
Bronchospasm associated with asthma or chronic obstructive pulmonary disease, croup, prominent rash associated with anaphylaxis provided all systemic signs have resolved and minor allergy associated with rash.
71
What are the contraindications and cautions for prednisone/prednisolone?
Contraindications- known severe allergy Caution- Less than 5 years for bronchospasm associated with asthma
72
What is the mechanism of action (MOA) of prednisone/prednisolone?
Prednisone is a prodrug metabolised to prednisolone in the liver. It is a corticosteroid with anti-inflammatory and immunosuppressant actions. It inhibits the production of inflammatory mediators such as prostaglandins and leukotrienes resulting in a reduction in the inflammatory and immune response.
73
What are the routes of administration for prednisone/prednisolone as a first responder?
Per oral (PO)
74
What are the dosages for prednisone/prednisolone administration as a first responder?
40mg for an adult. Refer to the pediatric drug dosage table for a child.
75
What are the side effects of prednisone/prednisolone administration?
Fatigue, sodium and water retention and gastrointestinal reflux.
76
Do you have to call clinical desk to administer prednisone/prednisolone as a first responder?
Yes
77
What are the indications for salbutamol administration as a first responder?
Bronchospasm secondary to asthma or COPD, prominent bronchospasm secondary to airway burns, smoke inhalation or chest infection, release syndrome following crush injury and known or suspected hyperkalaemia with ECG changes.
78
What are the contraindication and cautions for salbutamol administration?
Contraindications- Known severe allergy Cautions- none
79
What is the mechanism of action (MOA) of salbutamol?
It is a bronchodilator. It agonises beta 2 receptors.
80
What are the routes of administration for salbutamol as a first responder?
Nebulised and metered dose inhaler (MDI)
81
What are the dosages for salbutamol administration as a first responder?
5mg nebulised 1 puff (100mcg) of a metered dose inhaler (MDI) followed by six breaths up to six times.
82
What are the common side effects of salbutamol administration?
Tremor and tachycardia
83
Do you have to call clinical desk to administer salbutamol as a first responder?
For nebulised yes but if using the patients metered dose inhaler then no.
84
What are in indications for ipratropium administration as a first responder?
Bronchospasm secondary to asthma or COPD and prominent bronchospasm secondary to airway burns, smoke inhalation or chest infection.
85
What are the contraindications and cautions for ipratropium administration?
Contraindications- known severe allergy Cautions- none
86
What is the mechanism of action of ipratropium?
It is a bronchodilator. It is and anticholinergic agent with predominantly antimuscarinic activity. It antagonises acetylcholine receptors causing vagal inhibition resulting in bronchodilation.
87
What are your routes of administration for ipratropium as a first responder?
Nebulised
88
What are your dosages for ipratropium administration as a first responder?
0.5mg
89
What are the common side effects of ipratropium administration?
tachycardia, dry mouth and blurred vision.
90
Do you have to call clinical desk to administer ipratropium as a first responder?
Yes
91
What are the indications for glucagon administration as a first responder?
hypoglycaemia when the patient cannot safely swallow and IV access cannot be obtained.
92
What are the contraindications and cautions for glucagon?
Contraindications- Known severe allergy Cautions- none
93
What is the mechanism of action (MOA) of glucagon?
It increases the blood glucose level by stimulating glycogenolysis predominantly within the liver.
94
What are your routes of administration for glucagon as a first responder?
Intramuscular (IM)
95
What are your dosages for glucagon administration as a first responder?
1mg for an adult or child aged greater than or equal to 5 years 0.5mg for a child aged less than 5 years
96
What are the common side effects of glucagon administration?
None
97
Do you have to call clinical desk to administer glucagon as a first responder?
Yes
98
What are your indications for ondansetron as a first responder?
Clinically significant nausea and/or vomiting
99
What are the contraindications for ondansetron administration?
Contraindications- Known severe allergy, less than 1 year old, suspected serotonin syndrome. Cautions- none
100
What is the mechanism of action (MOA) for ondansetron?
It is an antiemetic. It antagonises serotonin receptors centrally in the brain and peripherally in the gastrointestinal tract resulting in a reduction in nausea and vomiting.
101
What are your routes of administration for ondansetron as a first responder?
Intramuscular (IM)
102
What are your dosages for ondansetron administration as a first responder?
4mg in a adult. Refer to pediatric drug dose table for a child
103
What are the common side effects of ondansetron administration?
Headache and flushing
104
Do you have to call clinical desk for ondansetron administration as a first responder?
Yes

Pharmacology (2 decks)

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